Laterally, there is significantly more room available at the talar neck than on the medial side. [Medline] . For the vast majority of articular fractures unlocked plates combined with screws provide adequate support. 23, No. 5. On the left an athlete with pain just above both ankles, more pronounced on the left than on the right. 166(5):1203-6. Tibial and Fibular Shafts Chapter 6 included proximal tibial fractures. The AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification was published as a compendium to the Journal of Orthopaedic Trauma (JOT) in 1996. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement. Long-term results of pilon fractures. After evaluating the patient, the fracture characteristics, and the integrity of the soft tissue envelope, operative fixation of a pilon fracture can proceed. Fractures of the lateral margin of the distal tibia are usually avulsion fractures of the anterior or posterior tibial tubercle, caused when the anterior or posterior inferior … Sirkin M, Sanders R. The treatment of pilon fractures. However, every effort should be made to retain all articular segments, irrespective of the soft tissue attachments. This can be corrected via the following: Manual traction, distracting between the proximal tibial and distal calcaneal pin, Use of the articulating distractor-compressor clamp, which can aid in gaining length in a controlled manner (Fig. distal tibia forms an inferior quadrilateral surface and pyramid-shaped medial malleolus; articulates with the talus and fibula laterally via the fibula notch; Vascular anatomy . 2005;87 (5): 692-7. Similarly, because of the intimate articulation between the tibia and fibula at the distal tibiofibular joint, angular deformity of the distal fibula in any plane will have implications on the tibial reduction. Indirect techniques to regain length may be necessary, especially in high-energy pilon fractures with significant shortening and soft tissue swelling. The approach facilitates accurate articular reduction combined with submuscular and subcutaneous plate applications spanning the metaphyseal comminution. 34.5). Locking plates are of minimal use in most distal tibial pilon fractures. 34.1). Unable to process the form. It is important to realize that in these cases the radiographs of the ankle may be … 3. A very useful tutorial on this topic can be found here.. Reference: Schatzker, J., et al. Pictorial Review: Cross-Sectional Imaging of the Foot and Ankle. This anatomy becomes most relevant when considering a treatment strategy for accurately reducing the tibial articular surface. Frequently, the important ligaments of the ankle remain largely intact after a pilon fracture, producing the commonly observed major fracture segments consisting of the posterolateral (Volkmann′s) fragment, the anterolateral (Chaput) fragment, and the medial fragment. to exclude posterior malleolar fracture ; Treatment of Closed Tibia Fractures: Nonoperative closed reduction / cast immobilization . The formulation of a cogent preoperative surgical plan begins with the evaluation of the injury films. The relevant surgical anatomy for the fixation of tibial pilon fractures includes osseous, ligamentous, muscular, and neurovascular structures. This criteria is based upon the position of the foot at the time of the injury, which is typically in a supination-external rotation position (4). This chapter will focus on the shaft of the tibia and fibula with respect to fracture management and leg length discrepancy. Consistent with the traditional principles of open fracture management, completely devitalized cortical (diaphyseal) fragments require removal. Maisonneuve fracture refers to a combination of a fracture of the proximal fibula together with an unstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (distal tibiofibular syndesmosis, deltoid ligament) and/or fracture of the medial malleolus. Most commonly, associated open wounds are located medially. Proximal extension of the incision is limited as well. 2004;183 (3): 615-22. ... CT is also helpful for exact fracture classification 1. Because of the complexity of these injuries, multiple surgical approaches are frequently required. The peroneal muscles (longus and brevis) occupy the lateral compartment of the leg, have a distal muscle belly posteriorly, and are firmly attached at the distal fibula by the peroneal sheath. indications closed low energy fxs with acceptable alignment < 5 degrees varus-valgus angulation These injuries are characterized by significant tibial shortening, often with an intact fibula (this pattern may be accompanied by severe articular involvement). (1993) ISBN:0387558373. Computed tomography (CT) scans should be delayed until limb length has been restored. 34.2).3 This classification system is much more detailed, describes comminution at multiple levels, and differentiates between partial and complete articular injuries. 1. 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